Last updated March 14, 2022

Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults

Recommendations

Insulin pump therapy without sensor augmentation

We recommend continuous subcutaneous insulin infusion (CSII) over analog-based basal-bolus multiple daily injections (MDI) in patients with type 1 diabetes mellitus (T1DM) who have not achieved their A1C goal, as long as the patient and caregivers are willing and able to use the device. (1-M)
699
We recommend CSII over analog-based basal-bolus MDI in patients with T1DM who have achieved their A1C goal but continue to experience severe hypoglycemia or high glucose variability, as long as the patient and caregivers are willing and able to use the device. (1-L)
699
We suggest CSII in patients with T1DM who require increased insulin delivery flexibility or improved satisfaction and are capable of using the device. (2-L)
699

Insulin pump therapy in type 2 diabetes mellitus

We suggest CSII with good adherence to monitoring and dosing in patients with type 2 diabetes mellitus (T2DM) who have poor glycemic control despite intensive insulin therapy, oral agents, other injectable therapy, and lifestyle modifications. (2-L)
699

Insulin pump use in the hospital

We suggest that clinicians continue CSII in patients admitted to the hospital with either type of diabetes if the institution has clear protocols for evaluating patients as suitable candidates and appropriate monitoring and safety procedures. (2-L)
699

Selection of candidates for insulin pump therapy

We recommend that before prescribing CSII, clinicians perform a structured assessment of a patient’s mental and psychological status, prior adherence with diabetes self-care measures, willingness and interest in trying the device, and availability for the required follow-up visits. (1-L)
699

Use of bolus calculators in insulin pump therapy


We suggest encouraging patients to use appropriately adjusted embedded bolus calculators in CSII and have appropriate education regarding their use and limitations. (2-L)
699

Real-time continuous glucose monitors in adult outpatients

We recommend RT-CGM devices for adult patients with well-controlled T1DM who are willing and able to use these devices on a nearly daily basis. (1-H)
699

We recommend real-time continuous glucose monitoring (RT-CGM) devices for adult patients with T1DM who have A1C levels above target and who are willing and able to use these devices on a nearly daily basis. (1-H)
699

Use of continuous glucose monitoring in adults with type 2 diabetes mellitus

We suggest short-term, intermittent RT-CGM use in adult patients with T2DM (not on prandial insulin) who have A1C levels ≥7% and are willing and able to use the device. (2-L)
699

Education and training on the use of continuous subcutaneous insulin infusion and continuous glucose monitoring

We suggest that adults with T1DM and T2DM who use CSII and continuous glucose monitoring (CGM) receive education, training, and ongoing support to help achieve and maintain individualized glycemic goals. (UGPS)
699

Recommendation Grading

Overview

Title

Diabetes Technology—Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults

Authoring Organization

Endorsing Organizations

Publication Month/Year

September 2, 2016

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

To formulate clinical practice guidelines for the use of continuous glucose monitoring and continuous subcutaneous insulin infusion in adults with diabetes.

Inclusion Criteria

Male, Female, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Long term care

Intended Users

Diabetes educator, dietician nutritionist

Scope

Treatment, Management

Diseases/Conditions (MeSH)

D003920 - Diabetes Mellitus, D003922 - Diabetes Mellitus, Type 1, D003924 - Diabetes Mellitus, Type 2, D061385 - Insulins, D007328 - Insulin, D015190 - Blood Glucose Self-Monitoring

Keywords

insulin pump, CGM, Continuous Glucose Monitoring

Source Citation

Anne L. Peters, Andrew J. Ahmann, Tadej Battelino, Alison Evert, Irl B. Hirsch, M. Hassan Murad, William E. Winter, Howard Wolpert, Diabetes Technology—Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, Volume 101, Issue 11, 1 November 2016, Pages 3922–3937, https://doi.org/10.1210/jc.2016-2534

Supplemental Methodology Resources

Data Supplement